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Primary care II > Menopause > Flashcards

Menopause Flashcards

1
Q

menopause occurs with

A

1000

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2
Q

Changes with estrogen loss

A 
increase ldl decrease hdl 
bone loss 
CNS- hot flashes nightsweats memory 
GI- decreased motility 
CV- vasodilation atherosclerosis 
GU- loss support vaginal vault
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3
Q 
Perimenopause
occurs \_\_\_\_ 
estrogen levels\_\_\_\_ 
biggest complaint\_\_\_\_ 
duration \_\_\_\_\_
A

occurs in 40s
estrogen levels rise/fall- unstable
biggest c/o menstrual irregularity
2-8 years (avg. of 5)

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4
Q

undergo menopause at earlier age

A 
smokers 
type I dm 
increased altitude 
undernourished/vegetarian
NO LINK to FH 
cancer
hysterectomy
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5
Q

what does progesterone do to uterus?

A

keeps it thin

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6
Q

women c/o skipping period and when it comes its heavy..what do you do?

A

biopsy
then progesterone only
progesterone iud
combo prog/estrog

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7
Q

women c/o nightsweats, moody irritable, light periods…what do you do?

A

SSRI: prozac, effexor

combo prog/estro

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8
Q 
menopause 
end of \_\_\_\_\_\_\_ 
cessation of menses for \_\_\_\_\_ 
surgical removal of \_\_\_\_\_\_ 
age \_\_\_\_\_\_
A

end of reproductive life
cessation of menses for 1 year
surgical removal of ovaries
age 50

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9
Q 
menopause etiology 
results from changes in \_\_\_\_\_ 
atresia of \_\_\_\_\_\_ 
fewer follicles decreased production of \_\_\_\_\_ (most potent) 
then \_\_\_\_\_ becomes primary E2 from \_\_\_\_\_
A

results from changes in ovaries
atresia of follicles
fewer follicles, decreased production of estradiol (most potent) E2
estrone becomes primary (from adipose tissue)

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10
Q

Lab tests
FSH >______ indicates menopause
Estradiol

A

FSH>40

Estradiol

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11
Q

menopause tx begins with

A

education

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12
Q

Hormone replacement therapy
Used for ________ menopause
Must be used in women with _________

A

used for symptomatic menopause

must be used in women with an intact uterus

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13
Q

Estrogen replacement therapy for women with_____

A

estrogen replacement therapy for women with hysterectomy

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14
Q

hrt forms

A

estrog/prog cyclic or continuous
(estrogen qd and prog 10 days)
continuous is better

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15
Q

Benefit of HRT

A

dec. flashes
improve genitourinary
dec. osteoporosis and cardiac (1st year inc.)
?dementia

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16
Q

Contraindications for HRT

A 
undx vaginal bleeding 
pregnancy 
hx thromboembolic episodes
liver disease 
cancer breast resp tract
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17
Q

HRT precaution

A 
type 1 dm 
gallbladder disease 
>1ppd 
obesity/elevated trig
fmh breast ca 
fibroid uterus (stimulated by estrogen) 
hx peripheral vascular 
migraines
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18
Q

HRT candidate

A 
menopause within 5 years 
good health 
no risk factors heart or breast (no first degree relative) 
nonsmoker 
nonobese 
normal bs and bp 
mod-sev sx
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19
Q

HRT risks

A

blood clots
gall bladder disease
breast cancer
cardiac in 1st year if prior heart disease

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20
Q

Breast cancer risk with HRT

A

10 increased risk

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21
Q

estrogen alone can be used for

A

7 years

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22
Q

estrogen progesterone can be used for

A

5 years

23
Q

estrogen replacement therapy drug options

A

premarin
menest
estradiol
transdermal (best- avoids liver, less trig and lipid)

24
Q

HRT drug options

A

provera or prometrium
combined: prempro, premphase, femHRT, activella, ortho-prefest, combipatch
duavee- estrogen with bazedoxifene ( reduce effect of estrogen on uterus)

25
Q

SE HRT

A

BTB (if continues over a year then eval)
Fibroids
Allergic
Virilization (testosterone products)
Progesterone: breast tenderness, fluid retention, weight gain, depression, irritability

26
Q

Sleep options

A

melatonin
gabapentin
lunesta

27
Q

Vasomotor pharmacology

A 
brisdelle (paroxetine) 
effexor
gabapentin 
clonidine 
SSRI: paxil, prozac, zoloft
28
Q

In 5-7 years following menopause a women will lose up to ______ of bone density

A

20%

29
Q

Osteoporosis risk factors

A 
history fx 
>50 
low E2 
women 
caucasian 
thin
30
Q

Bone density scan should be done on….

A 
>65 
fh 
small frame 
smoker, etoh, glucocorticoid 
postmenopausal not on hrt 
low activity 
early menopause 
hx rib, hip, forearm, vertebral fx
31
Q

USPSTF osteoporosis screening recommendation

A

65+ or 60 if increased risk

32
Q

Dexa screening
____ x ray
measures __,___,___

A

dual energy x ray

hip spine wrist

33
Q

BMD scores and retesting

A
  • 1 normal: 10-15 years
  • 1 to -2.5 osteopenia: 2-5 years
  • 2.5 osteoporosis: every year
34
Q

Frax test what it shows

A

BMD + predicts risk of breaking bone in 10 years

35
Q

BMD results and treatment
Normal
Low bone density
Osteoporosis

A

normal: ca and vit d healthy diet exercise
low bd: same + fosamax 1/2 strength
osteoporosis: same+ full strength + refer to endocrinology

36
Q

Calcium and vitamin d requirement

men?
over 65?

A

1200 mg whether HRT or not
400-800 vitamin D

men: 1000 mg
over 65: 1500 mg

37
Q

2 classes of osteoporosis meds and what their goals are

A

antiresorptive (biphosphonates): slow bone loss

anabolic parathyroid hormone: build bone

38
Q

biphosphonates dec risk of fracture by _____ over _____

A

50% over 2-4 years

39
Q

How to take biphosphonates

A

1st thing in the morning on an empty stomach with glass of water
30 mins before eating drinking
stay upright

40
Q

Boniva aka ____ is a ____ and is rx by ______ it is an __________

A

boniva aka ibandronate is a biphosphate rx by endocrine, it is an IV medication (or oral)

41
Q

risedronate aka

A

actonel atelvia

42
Q

zoledronic acid aka

prevention and treatment of

A

reclast

prevention and tx of steroid induced osteoporosis

43
Q

SE biphosphonates

A 
bone, joint, muscle pain 
nausea, heartburn 
uveitis 
ONJ- jaw necrosis 
spontaneous fx of femurs: >5 years drug holiday
44
Q

parathyroid hormone drugs for osteoporosis

A

teriparatide or forteo
denosunmab or prolia
injections

45
Q 
SERM aka 
is a \_\_\_\_\_ 
decreases \_\_\_\_\_\_ and \_\_\_\_\_ increases \_\_\_\_ 
contraindications: 
SE: 
\+ effect on \_\_\_\_, no risk of \_\_\_\_\_\_\_
A 
reloxifene or evista
is an estrogen modulator 
decreases bone turnover and resorption 
increases bone density 
contraindications: thromboembolic risk DVT in first 4 months
SE: leg cramps, hot flashes 
\+ effect chol, no risk breast/uterus
46
Q 
Calcitonin is for \_\_\_\_ 
for women >\_\_\_\_\_
suppresses \_\_\_\_\_\_ 
form\_\_\_\_\_ 
alternate\_\_\_\_ 
contraindications\_\_\_\_
SE:
A 
spine 
> 5 years postmenopausal 
suppresses osteoclast activity 
form nasal spray 
alternate nostrils 
contraindications: allergy or salmon 
SE: rhinitis, arthralgia, back pain, HA, epistaxis
47
Q

Interstitial cystitis aka
absence of ____
coexists with
what worsens symptoms??

A

bladder pain syndrome
absence of other etiology
coexcists with fibromyalgia, ibs
worsen sx: caffeine, etoh, fruit, tomato, spicy food

48
Q

Sx interstitial cystitis

A 
discomfort full 
relief with voiding 
urgency, frequency, nocturia 
pelvic tenderness
pain with sex
*urinary incontinence not a symptom
gradual onset, >6 months
49
Q

Causes interstitial cystitis

A 
unknown
?mast cell- inflammatory, histamine 
urine
changes in nerves 
immune system
50
Q

Findings in interstitial cystitis

A

tenderness lower abdomen

negative: urine, chlamydia, cystoscopy
dx: postvoid residual urine volume to r/o obstruction

51
Q

Tx interstitial cystitis

A 
Antihistamines (atarax, claritin)
TCA (imipramine, amitriptylline)
Pentosan (urology) 
Anti-inflammatories (advil) 
Urology for infusions (heprain, dimethyl sulfoxide)
52
Q

Overactive bladder def. and char.

A

muscles of bladder contrx involuntarily
urgency
incontinence (maybe)
frequency, nocturia (usually)

53
Q

Risk fx for overactive bladder

A 
Neurological 
High urine prod (diabetes, kidney disease) 
Medications 
UTI 
Bladder tumor/stone 
Outflow obstruction (prostate, constipation) 
Caffeine/ETOH 
Cognitive decline 
Ambulating 
Constipation 
Incomplete emptying
54
Q

Tx overactive bladder

A 
Fluid restrx 
Avoid caffeine 
Pelvic floor exercises 
Medications: antimuscarinic 
Oxybutynin (ditropan) 
Tolterodine (detrol) caution glaucoma (dry eyes, constipation)

Primary care II (13 decks)

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